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Abstract Details
Kinetics of emergence of liver complications in HCV-infected patients and advanced fibrosis, with and without HIV-coinfection, after SVR
AIDS. 2021 May 27. doi: 10.1097/QAD.0000000000002959. Online ahead of print.
Anaïs Corma-Gómez1, Juan Macías, Francisco Téllez, Luis Morano, Antonio Rivero, Miriam Serrano, María José Ríos, Francisco Jesús Vera-Méndez, Marta Santos, Luis Miguel Real, Rosario Palacios, Ignacio de Los Santos, Paloma Geijo, Arkaitz Imaz, Dolores Merino, Maria José Galindo, Sergio Reus-Bañuls, Miguel Ángel López-Ruz, Carlos Galera, Juan A Pineda, on belhaf of RIS-HEP13 and GEHEP 011 study groups
Author information
1Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme. Seville. Spain Unit of Infectious Diseases, Hospital Universitario de Puerto Real, Faculty of Medicine, Cadiz, Spain Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Córdoba, Spain Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain Unit of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla, Spain Section of Infectious Medicine/Service of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena, Spain Unit of Internal Medicine, Hospital Universitario del SAS de Jerez, Cadiz, Spain Unit of Immunology, Biochemistry, Molecular Biology and Surgery, Faculty of Medicine, Universidad de Málaga, Spain Unit of Infectious Diseases and Microbiology, Hospital Virgen de la Victoria, Málaga, Spain Unit of Internal Medicine and Infectious Diseases, Hospital La Princesa, Madrid, Spain Unit of Infectious Diseases, Hospital Virgen de la Luz, Cuenca, Spain HIV and STI Unit, Department of Infectious Diseases. Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain Unit of Infectious Diseases, Hospital Juan Ramón Jiménez, Huelva, Spain Unit of Infectious Diseases. Hospital Clínico Universitario de Valencia. Spain Unit of Infectious Diseases, Hospital General Universitario de Alicante. Spain Unit of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Granada. Spain Unit of Infectious Diseases, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia. Spain.
Abstract
Objective: There is scarce available evidence on the distribution over time of liver complications emergence in hepatitis C virus (HCV)-infected patients who achieve sustained virological response (SVR) with direct-acting antiviral (DAA)-based therapy. Therefore, we aimed at describing the kinetics of liver-related events appearance in this setting.
Design: Multicentric prospective cohort study.
Methods: HCV-monoinfected and HIV/HCV-coinfected patients from GEHEP-011 cohort, whose inclusion criteria were: 1) Had achieved SVR with DAA-based therapy; 2) Liver stiffness (LS) prior to starting treatment≥ 9.5 kPa; 3) Available LS measurement at SVR. SVR was considered as the baseline time-point.
Results: 1035 patients were included, 664 (64%) coinfected with HIV. Before DAA-based therapy, 63 (6.1%) individuals showed decompensated cirrhosis. After SVR, 51 (4.9%) patients developed liver complications. Median (Q1-Q3) time to the emergence of hepatic events was: hepatic encephalopathy 11 (7-24) months, ascites 14 (6-29) months, hepatocellular carcinoma (HCC) 17 (11-42) months and portal hypertension gastrointestinal bleeding (PHGB) 28 (22-38) months (p = 0.152). We define two profiles of liver complications: those emerging earlier (encephalopathy and ascites) and, those occurring continuously during the follow-up (HCC, PHGB) [median (Q1-Q3) time to emergence 12.7 (6.6-28.2) months vs. 25.4 (12.5-41.53) months, respectively (p = 0.026)].
Conclusions: The vast majority of HCV-infected patients who develop liver complications after reaching SVR with DAA do it within three years after SVR time-point. Specifically, hepatic encephalopathy and ascites do not usually emerge after this period. Conversely, HCC and PHGB may occur in longer term. It is critical to identify patients at risk of developing hepatic events to continue performing surveillance for them.